Amoebic liver abscess in pregnancy: report of two cases.

Amoebic liver abscess is a rare complication of pregnancy. It however, carries significant morbidity and because the diagnosis is often delayed, physicians in developing countries need to be reminded of its possibility when patients present with right lower chest and abdominal pain. This study presents the clinical reports of two cases in which the diagnosis was delayed and review the literature on amoebic liver abscess in pregnancy.

The effect of traditional herbal medicines on pregnancy outcome. The King Edward VIII Hospital experience.

OBJECTIVE: To determine the effect of herbal medication in pregnancy. METHOD: Patients (N = 229) presenting in early labour were randomly selected and interviewed. All interviews were conducted by one of the authors (MHM) familiar with the nuances of the Nguni languages. RESULTS: One hundred and twenty-six patients (55%) gave a positive history of herbal ingestion (study group) and 103 (45%) had a negative history (control group). Fifteen per cent of the control group and 55.6% of the study group had grade II-III meconium staining of liquor, while 22% of the control group and 38.5% of the study group were delivered by caesarean section. CONCLUSION: Herbal medication is commonly used in pregnancy by women attending King Edward VIII Hospital. Its use may lead to fetal distress, as indicated by the high frequency of meconium-stained liquor and high caesarean section rates in this group of women presenting in labour.

The use of traditional herbal medication during pregnancy.

PIP: A survey of 577 pregnant women attending their first antenatal visit at King Edward VIII Hospital in Durban, South Africa, in 1995 revealed widespread use of herbal medications. 60% of these women had a secondary or tertiary education. 498 women (86.3%) knew about Isihlambezo (herbs taken during pregnancy for cleansing) and 252 women (43.7%) were currently taking medicinal herbs. The two most common sources of knowledge about these medicines were parents/relatives (69.8%) and traditional birth attendants/herbalists (22.6%). 28.5% of non-users indicated they had been advised by doctors not to take the herbs. In most cases, herbal medicine use--generally a daily oral dose--was initiated in the second trimester of pregnancy. Most commonly, such remedies were ingested to improve fetal conditions (45.2%) or make labor easier (16.7%). Conditions such as childhood malnutrition, congenital malformations, tumors, and acute renal failure have been linked to toxic or carcinogenic constituents present in herbal medicines taken during pregnancy. Further research is needed to determine the side effects of Isihlambezo on the pregnant woman, the fetus, the labor process, and the outcome of pregnancy. Moreover, there is a need to identify the active chemical substance in herbal medications, establish their pharmacokinetics, determine whether their use can be clinically identified without reliance on patient self-report, and to develop antidotes. The antagonistic stance of medical practitioners toward herbalism tends to exacerbate the distance between traditional and modern medicine in Africa.^ieng

Advanced extra-uterine pregnancy associated with eclampsia. A report of 2 cases.

Two patients with advanced extra-uterine pregnancies developed fulminating pre-eclampsia, providing firm evidence that the uterus is not essential to the process of pre-eclampsia.

The incidence of major abdominal surgery after septic abortion--an indicator of complications due to illegal abortion.

That there is a high morbidity associated with illegal abortion is well known, but its exact extent is difficult to assess, since detailed statistics are not available and the nature of the morbidity is diffuse. We have assumed that abortal sepsis is a consequence of illegal interference with pregnancy. The incidence of major abdominal surgery after a septic abortion is used as an indicator of serious complications. This incidence is compared with that following legal abortion.

Rupture of the gravid uterus.

A detailed analysis of 129 cases of rupture of the gravid uterus between 1980 and 1983 is presented and compared with two previous reports from King Edward VIII Hospital, Durban, over the last 2 decades. Statistically significant decrease in the occurrence of this condition (from 2,7 to 1,06/1000 deliveries (P less than 0,001; chi 2 = 20,38)) and in the maternal mortality rate (from 12% to 3%) have taken place since the initial study. The most probable reasons for this improvement are the provision of a community-based obstetric service, the early detection of cephalopelvic disproportion, awareness of the condition, immediate and adequate resuscitation once the diagnosis is established, and the performance of a total abdominal hysterectomy as definitive treatment in most cases.

Peritoneal tuberculosis imitating ovarian carcinoma "special category".

A case report, of a patient with peritoneal tuberculosis in whom the provisional diagnosis of ovarian carcinoma--"special category" was made is presented. As most gynecologists see hardly any cases of peritoneal tuberculosis nowadays, this possible diagnosis--which should always be considered--is reviewed. It illustrates the importance of a definite histopathological diagnosis.

Anti-lipopolysaccharide immunotherapy in management of septic shock of obstetric and gynaecological origin.

Freeze-dried human plasma rich in anti-lipopolysaccharide (anti-LPS) immunoglobulin G was used to treat septic shock (systolic pressure less than or equal to 80 mm Hg, central venous pressure greater than or equal to 6 cm H2O) in obstetric and gynaecological patients. Mortality in conventionally treated patients was 9/19 (47.4%) compared with 1/14 (7.1%) in anti-LPS-treated patients. Anti-LPS caused the mean arterial pressure to rise from 45.1 +/- 7.36 mm Hg to 69.1 +/- 9.07 mm Hg within 75 min of administration. The mean hospital stay of survivors was 28.1 days for controls and 14.2 days for the anti-LPS-treated patients. The development of complications of septic shock was much reduced in the treated group. Anti-LPS thus appears significantly to reduce mortality and morbidity in septicaemia.

Hypomagnesaemia-hypocalcaemia syndrome in the postpartum period. A case report.

A black woman had amoebic dysentery for 5 days before delivery of her 7th child. The day after delivery at home she was admitted to hospital with puerperal sepsis, vaginal bleeding and dysentery. The patient received gentamicin from the 4th to the 10th day after admission and the diarrhoea continued until the 11th day, when she developed tetany. Investigation revealed hypocalcaemia, hypomagnesaemia and hypokalaemia; urinary magnesium excretion was at the upper limit of the reference range; infusion of parathyroid hormone adenosine monophosphate excretion. Magnesium replacement therapy was instituted and normal serum calcium, magnesium and potassium levels were re-established on this treatment alone. These findings are interpreted as being consistent with magnesium depletion by diarrhoea and gentamicin therapy, resulting in the induction of a functional hypoparathyroidism.